[논문]A Context-oriented Communication Algorithm for Advance Care Planning : A Model to Assist Palliative Care in Heart Failure

Kim, JinShil; Kim, Shinmi; Shin, Mi-Seung; Jin, Jae Ok; Kim, Yunmi; Lee, Mee-Ok

doi:10.1097/jcn.0000000000000396

A Context-oriented Communication Algorithm for Advance Care Planning : A Model to Assist Palliative Care in Heart Failure

The Journal of cardiovascular nursing, v.33 no.5, 2018년, pp.446 - 452

Kim, JinShil , Kim, Shinmi , Shin, Mi-Seung , Jin, Jae Ok , Kim, Yunmi , Lee, Mee-Ok

Abstract ▼ AI-Helper

Background:Access to consultation or referral for decisions about advance care planning (ACP) is limited, particularly for nonmalignant models pertinent to palliative care in heart failure (HF).Objectives:The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions.Methods:Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model.Results:A consensus was determined based on a content validity ratio (CVR) of 0.318 or greater, a critical value for selection of an item scored as important (≥4 on a 5-point Likert scale). A total of 50, 44, and 38 experts in Korea completed each round, respectively. Item evaluation did not differ across rounds (Friedman χ2>P= .05), except for timing of the ACP discussion. A lack of consensus was observed on the issue of after HF diagnosis for right timing of the ACP discussion across rounds (CVRs from −0.80 to −0.83); consensus was reached on the expectation of a terminal state (CVRs from 0.60 to 0.78). Content validity ratios were moderately high for Korean advance directive, ranging from 0.59 to 0.91. Experts also reached consensus about each of 5 steps of a communication model-patients’ determination of decisional capacity (CVR, 0.72-1.0), awareness (CVR, 0.95-1.0), willingness for advance care planning (CVR, 0.76-0.84), family dynamics (CVR, 0.92-1.0) and patient readiness for advance care planning (CVR, 0.76-0.95).Conclusions:A context-oriented communication model could be used to facilitate the decision-making process for palliative care and continuity of care in HF.

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